A prospective observational study to know the origin of lymphorrhea in post-renal transplant patients using creatine phosphokinase and lactate dehydrogenase

Introduction: Renal transplantation provides the best result as a long-term renal replacement therapy. Lymphorrhea is considered a common surgical complication of renal transplantation. Although nonsurgical factors are also associated, it is primarily due to damage and improper ligation of lymphatic vessels draining donor kidney and perivascular lymphatics of iliac vessels. Lymphorrhea is associated with prolongation of hospital stay and increased chances of infection and it may lead to lymphocele formation. Hence, to localize the origin of postoperative lymphorrhea in transplant recipients in wake for its definitive management, the enzymatic activity of the two enzymes, namely, creatine phosphokinase (CPK) and Lactate dehydrogenase (LDH) in the drain fluid was evaluated. Materials and Methods: A total of 68 renal transplant recipients (including live and deceased-donor [DD] transplantation) were evaluated for2 years. The enzymatic value of CPK and LDH was calculated in perigraft drain fluid. It was compared with the values of CPK and LDH in postradical cystectomy pelvic drain fluid and simple renal cortical cyst fluid. The average value of CPK in pelvic drain fluid and LDH in renal cortical cyst fluid was considered as their baseline value in lymphatics draining lower limb and renal lymphatics, respectively. Results: The source for postoperative lymphorrhea in DD and live-related donor was iliac lymphatics, whereas in live unrelated donor, it was iliac and graft kidney lymphatics. Conclusion: Drain fluid assessment for CPK and LDH activity can localize the origin of lymphatic leak in renal transplant recipients.